CANADA : PROVINCIAL MEDICINE VARIES.

COMMENT: For non-Canadian readers, the practice of Canadian medicine varies according to Provincial political decisions. Private Hospitals legally exist in QUEBEC. Payment for expensive medication varies according to Provincial political policy. QUEBEC and ALBERTA are the most generous, (allowing MDs to make independent clinical decisions). Ont.Med Review Nov. 2013. The Ont.Govt has reduced all fees by 0.5% about $1000 a year for a GP. New political controls for Optical Coherent Tomography, colonoscopy and cervical cancer screening. Patients can get "private medicine" ,which is officially not permitted by the Canada Health Act (except in Quebec), by subscribing about $3000/year to "Wellness Clinics" which use a legal device providing non-Gov.-paid advice from Dietitians, Physiotherapists et al. Examples in Toronto are Cleveland clinic Canada, MedCan, MediSys, together with GPs with Executive clients. MDs are not permitted to practice in Provinces where they are not licenced. Lawyers can practice in another Province for 100 days a year. An Ontario MD in Ottawa cannot practice across the river in Hull,Quebec.

Toronto Univ..SUNNYBROOK HOSP. :Paroxysmal Nocturnal Haematuria.

Paid by OHIP: approx $250,000 a year. Soliris® (eculizumab), is a first-in-class terminal complement inhibitor discovered, developed and commercialized by ALEXION pharmaceuticals,Inc.. Soliris is approved for the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH)1, a progressive and life-threatening disease characterized by the excessive destruction of red blood cells (hemolysis).1,2,3 Soliris is the first and only therapy approved for the treatment of PNH to reduce hemolysis. In the United States and European Union, Soliris is also approved for the treatment of patients with atypical hemolytic uremic syndrome (aHUS), an ultra-rare, life-threatening, genetic disease that can progressively damage vital organs, leading to stroke, heart attack, kidney failure and death.4,5 Soliris is the first and only therapy approved for the treatment of aHUS. Specifically, Soliris is indicated for the treatment of patients with aHUS to inhibit complement-mediated thrombotic microangiopathy, or TMA. The effectiveness of Soliris in aHUS is based on the effects on TMA and renal function. Prospective clinical trials in additional patients are ongoing to confirm the benefit of Soliris in patients with aHUS. Soliris is not indicated for the treatment of patients with Shiga toxin E coli-related hemolytic uremic syndrome (STEC-HUS). Soliris works by selectively targeting and blocking the complement cascade—a normal part of the immune system that, when activated inappropriately, plays a role in serious diseases like PNH and aHUS. Soliris has earned some of the pharmaceutical industry’s highest honors for innovation, including the 2008 Prix Galien USA Award for Best Biotechnology Product with broad implications for future biomedical research and the 2009 Prix Galien France Award in the category of Drugs for Rare Diseases. To learn more about Soliris, visit www.Soliris.net. Sunnybrook Haematology Dept: Prof. Richard A.WELLS MD(Newfoundland 1985) D.Phil(Oxon) FRCPC (Int.Med & Haematology).

LESLIE DAN SCHOOL of PHARMACY Prof C. GIULIVI

CPIN DISTINGUISHED LECTURE – November 1, 2013 Speaker | Dr. Cecilia Giulivi, Professor of Biochemistry, Department of Molecular Biosciences, University of California at Davis, CA Title | Role of environmental exposures in mitochondrial dysfunction and autism Date | Friday, November 1, 2013 Time | 9:30 am Location | Room PB150, Pharmacy Building, 144 College St., Leslie Dan Faculty of Pharmacy Host | Dr. David R. Hampson, Professor, Department of Pharmaceutical Sciences Co-Sponsor | Department of Pharmaceutical Sciences

GAIRDNER AWARDEE Dr. H.J.ALTER

TORONTO GAIRDNER AWARDS ($100,000) : USA NIH Dr.Harvey J. ALTER co-discoverer of AUSTRALIA ANTIGEN Lectured on Hepatitis C at the Sir Ka-shing LI GBM,KBE building of St.Michael's Teachimg hospital. Advised testing 48-68 age group. (Many used IV drugs between 1945 - 1965) 50% carriers not identified. 1-3% Worldwide infection. 60-70% show slow disease progress over 30 years 20- 30% develop cirrhosis in 15-40 years <5% develop cirrhosis in 5-10 years. Increased prevalence of Liver cancer due to Hep.C.

2013 James Arthur GAIRDNER AWARDS

Stockbroker JAMES ARTHUR GAIRDNER, LLD 1893-1971 Bequeathed his house to the town of Oakville as an art gallery. While he had always had an interest in medicine, it was the onset of severe arthritis in his early 50s that led Gairdner to become involved with the newly created Canadian Arthritis and Rheumatism Society. In 1957 he donated $500,000 to establish a foundation to recognize major research contributions in the conquest of disease and human suffering. Gairdner’s decision to create awards ($100,000)that recognize outstanding discoveries by the world’s top scientists was, and continues to be, an act of extraordinary vision. Much of his original instruction regarding the process of selection and awarding of the prizes remains in place today, contributing to the current stature of the Canada Gairdner Awards. - See more at: http://www.gairdner.org/content/james-arthur-gairdner-lld-1893-1971#sthash.J9YVdn07.dpuf

WSIB INSURANCE for MEDICAL OFFICES

Although NOT MANDATORY, Ontario MDs can insure themselves and staff for Occupational injury, illnesses, and death cheaply by WSIB at the rate of 73 cents per every $100 of OHIP income and staff salary. For $200,000, yearly premium would be $1460,(about $28 a week) Correspondence with the Late WSIB Chmn Hon.Lincoln Alexander QC will show that provided contact with communicable illness is noted in an office diary, the MD and Staff would be covered by WSIB if infected. Estate of SARS-killed GP Nestor YANGA received nothing from the Ont Govt as he`was "self-employed". Had he been covered by WSIB his Estate wiould have received approx $100,000.

MEDICO-LEGAL SOC TORONTO NOV. 6 Wed.

MLST Dinner Program: Brian Cuthbertson et al. v. Hassan Rasouli Wednesday, November 6, 2013 5:30 p.m. Reception, 6:00 p.m. Dinner 7:00 p.m. Presentations Metropolitan Hotel (Soon to be Doubletree by Hilton - 108 Chestnut Street, Toronto) On Friday October 18th, the Supreme Court of Canada released its decision in Brian Cuthbertson, et al. v. Hassan Rasouli by his Litigation Guardian and Substitute decision-maker, Parichehr Salasel (Ont) (34362). A 5-2 majority of the Supreme Court in Rasouli dismissed the appeal. The majority found that withdrawal of life support requires consent because the act of withdrawing life support is treatment, as it serves a “health-related purpose” by preventing suffering and indignity at the end of life, is closely associated with palliative care, and entails physical interference. The Court held that the withdrawal of life support “impacts patient autonomy in the most fundamental way.” The Supreme Court drew a distinction between the withdrawal of life-sustaining treatments and that of other medical services. The MLST has convened a panel of physicians and lawyers with intimate knowledge of the case to comment on the future implications of the decision for physicians, hospitals and lawyers. Be prepared to attend what promises to be a very lively and informative event -with perspectives on the case that only The Medico-Legal Society of Toronto can present. Program Chair: Daphne Jarvis, Borden Ladner Gervais LLP and First Vice-President, MLST Other Commentators: Andrew Faith, Polley Faith, LLP and Member of Council, MLST Dr. Andrew Baker, Chief of Critical Care Medicine, St. Michael's Hospital and Member of Council, MLST